News: PQI Profiles

How a Texas Nurse Successfully Improved Discharge Education at Her Hospital

Tuesday, February 12, 2019  
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By Siena Davis, MPH, Project Manager, PQI

In 2017, Angie Wise was working as a mom/baby nurse and the charge nurse at a small hospital in Texas. While she was reviewing results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, she discovered that patient satisfaction scores were plummeting. She decided to look for a trend in her unit that could be changed to improve patient satisfaction. Angie found that the discharge process was not adequately meeting patients’ needs, due to limited time and constant interruptions of the nurses.


Around the same time, Angie became aware that there were high rates of maternal mortality in both the U.S. and Texas. She wondered what the correlation was between discharge education and maternal mortality. After some research, she learned that improved discharge education could play a major role in reducing maternal mortality. She wondered, “Before [patients] go out the door, what can we do to improve our score and lessen the trend of maternal mortality?” She realized improving discharge education was the answer!


Angie was excited to discover that a tool had already been created to educate nurses about discharge education. After watching the Institute for Perinatal Quality Improvement’s Improving POSTBIRTH Education module, Angie thought, “This is one area that I can implement into my bedside nursing.” She felt that a quality improvement (QI) project aimed at improving HCAHPS scores, related to discharge education, would have positive impacts on nurses and patients.


Angie was a little concerned about getting buy in for the QI project, especially from more experienced nurses at her hospital. Despite these hesitations, she decided to introduce the idea to her manager. Angie said to her manager, “patients are saying they aren’t being educated.” She even brought documentation and data to support her point. Angie told her manager about the module and explained that improved discharge education would lead to improved HCAHPS scores. Her manager agreed and was eager to implement the module as an online education tool. Once the education department approved the module, all nurses in the unit were required to view it. Angie’s manager asked the nurses to discuss portions of the module during staff meetings.


After viewing the module, one dedicated staff nurse got approval to develop a discharge education class using components from the module. The hospital now holds a mandatory class to teach new mothers about warning signs, such as bleeding, depression, and obstructed breathing, for about 45 minutes each day. This has allowed the nurse who teachers the class to discuss topics in more depth than was possible before (when nurses were teaching mothers one-on-one for 5-7 minutes).


The primary goal of the QI project was to increase HCAHPS scores, related to discharge education, from 85% to high 90s. This goal was accomplished! In addition to increasing HCAHPS scores, the project increased the hospital’s bottom line, resulted in a discharge education class, and helped nurses realize the value of post birth education. Angie explained, “What went well was that all of the nurses realized that the contribution they make at this critical portion, though it may seem small - when you look at the importance of post-birth education, when you look at numbers, rates, graphs - it is astounding. You are keeping this patient from coming back. Hopefully, from dying. Nothing that you do is too small.”


Angie's advice to others who are thinking about engaging in QI:


  • “Get involved in professional organizations.”
  •  “Stay on top of research.”
  •  “Begin to think out of the box.”
  •  “Find the niche. You will be amazed what will grow out of it.”
  •  “You don’t have to reinvent the wheel.”
  •  “Don’t be afraid to put a QI project on the Map.”
  •  “Be enthusiastic consistently.”
  •  “Don’t even think that your contribution won’t matter.”

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